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Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes.
World J Gastroenterol. 2014 Dec 14; 20(46):17568-77.WJ

Abstract

AIM

To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).

METHODS

Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI.

RESULTS

The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs < 65: 1.57; 95%CI: 1.21-2.04) were at higher odds of being readmitted to hospital. Patients with duodenal ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95%CI: 1.34-2.23), and being readmitted to hospital (OR = 1.54; 95%CI: 1.19-1.99) when compared to gastric ulcers.

CONCLUSION

UGIB secondary to PUD, particularly duodenal ulcers, was associated with significant morbidity and mortality. Early readmissions increased over time and occurred more commonly in rural areas.

Authors+Show Affiliations

Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

25516672

Citation

Quan, Samuel, et al. "Upper-gastrointestinal Bleeding Secondary to Peptic Ulcer Disease: Incidence and Outcomes." World Journal of Gastroenterology, vol. 20, no. 46, 2014, pp. 17568-77.
Quan S, Frolkis A, Milne K, et al. Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. World J Gastroenterol. 2014;20(46):17568-77.
Quan, S., Frolkis, A., Milne, K., Molodecky, N., Yang, H., Dixon, E., Ball, C. G., Myers, R. P., Ghosh, S., Hilsden, R., van Zanten, S. V., & Kaplan, G. G. (2014). Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. World Journal of Gastroenterology, 20(46), 17568-77. https://doi.org/10.3748/wjg.v20.i46.17568
Quan S, et al. Upper-gastrointestinal Bleeding Secondary to Peptic Ulcer Disease: Incidence and Outcomes. World J Gastroenterol. 2014 Dec 14;20(46):17568-77. PubMed PMID: 25516672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. AU - Quan,Samuel, AU - Frolkis,Alexandra, AU - Milne,Kaylee, AU - Molodecky,Natalie, AU - Yang,Hong, AU - Dixon,Elijah, AU - Ball,Chad G, AU - Myers,Robert P, AU - Ghosh,Subrata, AU - Hilsden,Robert, AU - van Zanten,Sander Veldhuyzen, AU - Kaplan,Gilaad G, PY - 2013/03/02/received PY - 2014/05/15/revised PY - 2014/05/26/accepted PY - 2014/12/18/entrez PY - 2014/12/18/pubmed PY - 2015/9/12/medline KW - Digestive system surgical procedures KW - Endoscopy KW - Epidemiology KW - Incidence KW - Mortality KW - Peptic ulcer hemorrhage KW - Validation studies SP - 17568 EP - 77 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 46 N2 - AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD). METHODS: Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI. RESULTS: The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs < 65: 1.57; 95%CI: 1.21-2.04) were at higher odds of being readmitted to hospital. Patients with duodenal ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95%CI: 1.34-2.23), and being readmitted to hospital (OR = 1.54; 95%CI: 1.19-1.99) when compared to gastric ulcers. CONCLUSION: UGIB secondary to PUD, particularly duodenal ulcers, was associated with significant morbidity and mortality. Early readmissions increased over time and occurred more commonly in rural areas. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25516672/Upper_gastrointestinal_bleeding_secondary_to_peptic_ulcer_disease:_incidence_and_outcomes_ L2 - http://www.wjgnet.com/1007-9327/full/v20/i46/17568.htm DB - PRIME DP - Unbound Medicine ER -